Most older adults will develop one or more chronic illnesses with which they may live for years, often with symptom distress and progressive functional dependence. There is now abundant evidence that the quality of life during these advanced stages of disease is poor. The goal of this OAIC is to establish a research program focused on the relationship of pain and other symptoms to independence and function in older people with serious illness. The OAIC is built from a foundation of grants totaling $34.4 million started by the Center's principals in the late 1990s. These grants have spawned an additional 42 grants totaling $18.8 million supporting research, career development, and infrastructure. In this proposal, we expand this research foundation through strengthened collaborations with colleagues in Psychiatry, Medicine, Orthopedics and at the Hebrew Home for the Aged, among others. These collaborations are the source for new research projects and junior faculty with interests in geriatrics and palliative care. Three of the OAIC cores will be led by individuals who have devoted their careers to geriatrics, a fourth is led by an expert in clinical trials methods who is CAQ'ed in geriatrics, and the fifth is led by a senior gerontologist. The OAIC will recruit and train academic leaders, and it will support pilot and exploratory studies. It will also establish 2 research cores (research design and analysis, measurement and data management) that will apply innovative methods not currently in widespread use in aging research but that are highly applicable to aging. The Center will bring together a) leadership by senior geriatricians who are long-standing colleagues with a shared track record of successful research and training program building;b) senior faculty with a substantial body of research contributions;and c) promising junior investigators. Our Center's theme has its roots in the deepest traditions of medicine: attention to the primacy of the relief of suffering. Ancient though this priority may be, medical research in general, and geriatric research in particular, are poised to bring modern techniques and knowledge to what is in fact a new area of focus for the OAIC program - the effective amelioration of pain and other symptoms to improve function and promote independence in older adults. The proposed Center will bridge geriatrics and palliative care and serve as a model for a new focused area of research within geriatrics. PUBLIC HEALTH RELEVANCE: Substantial data suggest that the care of older adults living with serious illness is in need of improvement. The proposed OAIC would establish a sustainable infrastructure to support the development of new investigators in geriatric palliative care research, support research in geriatric palliative care, and develop or adapt instruments, designs, and analytic methods necessary to improve care for seriously ill older adults.